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The Rviat In Cardiac Surgery Assessing Postoperative Pulmonary Function Compared To Conventional Incision
Fudong Fan;
The Affiliated Hospital of Nanjing University Medical School, Nanjing,Jiangsu Province, China
BACKGROUND:Similar to the conventional median sternotomy employed in cardiovascular surgery, minimally invasive approach has emerged as a viable option for cardiac procedures. Unlike certain minimally invasive techniques that necessitate unilateral pulmonary ventilation during surgery, the right vertical infra-axillary thoracotomy (RVIAT) approach does not require such a procedure. Our objective was to explore the potential impact of the RVIAT approach on postoperative pulmonary function.
METHODS:Our study comprised 292 surgical patients diagnosed with congenital heart disease and valvular heart disease, undergoing either right vertical infra-axillary thoracotomy or median incision surgery between 2018 and 2023. We obtained baseline data for this study by conducting t-tests and chi-square tests on the basic information of the patients. Employing univariate logistic regression analysis on data obtained from these two groups, we investigated the association between employing the RVIAT approach and the subsequent impact on postoperative pulmonary function in patients. Continuous variables are presented by median and quartile, while categorical variables are presented by population and percentage results. P<0.05 was considered statistically significant.
RESULTS:Of the 292 patients included in the study, 228 patients underwent surgery via the traditional median sternotomy approach, resulting in 2 postoperative deaths. While 64 patients underwent surgery utilizing the RVIAT approach, leading to 1 postoperative death. Patients who underwent cardiac surgery through a median thoracotomy approach were older than those who underwent the RVIAT approach (RVIAT Approach vs. Conventional Incision: 61.00 [52.00, 67.00] vs. 40.50 [26.00, 54.25], p<0.001), and the two groups had similar Body Mass Indexes (BMI) (RVIAT Approach vs. Conventional Incision: 23.85 [20.76, 26.03] vs. 21.61 [20.14, 24.22], p=0.004). Comparing patients undergoing surgery through the RVIAT approach with those opting for the traditional median sternotomy approach, we found no significant reduction in surgical duration (RVIAT Approach vs. Conventional Incision: 275.00 [237.50, 330.00] vs. 285.00 [232.50, 350.00], p=0.536). However, the duration of extracorporeal circulation during the surgical procedure was relatively decreased (RVIAT Approach vs. Conventional Incision: 141.50 [100.00, 184.50] vs. 149.00 [123.00, 195.00], p=0.058). Postoperatively, the hospital stay duration was significantly reduced (RVIAT Approach vs. Conventional Incision: 9.00 [8.00, 12.00] vs. 12.00 [10.00, 15.00], p<0.001, OR=0.8101, 95%CI: 0.726-0.891), along with a notable decrease in mechanical ventilation duration (RVIAT Approach vs. Conventional Incision: 5.00 [3.88, 9.12] vs. 10.00 [6.00, 16.50], p<0.001). Moreover, postoperative pulmonary function exhibited marked improvement (P/F: RVIAT vs. Conventional Incision: 233.34 [146.18, 334.94] vs. 354.99 [277.27, 422.88], p<0.001, OR=1.003, 95%CI: 1.001-1.005).
CONCLUSIONS:Compared to traditional median sternotomy, patients undergoing cardiac surgery via the RVIAT approach experience less postoperative pulmonary function impairment. This improvement is attained without lengthening the extracorporeal circulation duration during the surgical process. Furthermore, the RVIAT approach effectively diminishes the postoperative duration of mechanical ventilation and hospital stay, thereby positively influencing patient prognosis.
Forest map of univariate analysis of relevant indicators in patients with right axillary straight incision approach versus traditional conventional incision.
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